Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, Miami, FL, USA.
Adv Exp Med Biol. 2012;728:107-25. doi: 10.1007/978-1-4614-0887-1_8.
Chronic kidney disease (CKD) is a growing public health epidemic that is associated with a markedly increased risk of cardiovascular mortality. Disordered mineral metabolism and particularly, disordered phosphorus metabolism appears to be a contributing factor. Fibroblast growth factor 23 (FGF23) regulates phosphorus and vitamin D metabolism. Its levels increase progressively beginning in early CKD, presumably as a physiological adaptation to maintain normal serum phosphate levels or normal phosphorus balance. FGF23 promotes phosphaturia and decreases production of calcitriol. Recent studies suggest that increased FGF23 is associated with mortality, left ventricular hypertrophy, endothelial dysfunction and progression of CKD. These results were consistently independent of serum phosphate levels. At the very least, FGF23 is emerging as a novel biomarker that may help identify which CKD patients might benefit most from aggressive management of disordered phosphorus metabolism. It is also possible that markedly increased FGF23 levels in CKD could contribute directly to tissue injury in the heart, vessels and kidneys, an exciting question that is sure to be the topic of intense investigation in the near future.
慢性肾脏病（CKD）是一种日益严重的公共卫生流行病，与心血管死亡率显著增加有关。矿物质代谢紊乱，特别是磷代谢紊乱似乎是一个促成因素。成纤维细胞生长因子 23（FGF23）调节磷和维生素 D 代谢。其水平从早期 CKD 开始逐渐升高，大概是为了维持正常的血清磷酸盐水平或正常的磷平衡的生理适应。FGF23 促进磷的排泄并减少 1,25-二羟维生素 D3 的生成。最近的研究表明，FGF23 的增加与死亡率、左心室肥厚、内皮功能障碍和 CKD 的进展有关。这些结果与血清磷酸盐水平无关。至少，FGF23 作为一种新的生物标志物出现，它可能有助于识别哪些 CKD 患者可能从积极管理磷代谢紊乱中获益最大。也有可能是 CKD 中明显增加的 FGF23 水平直接导致心脏、血管和肾脏的组织损伤，这是一个令人兴奋的问题，肯定会成为未来不久的研究热点。
